Fall rituals in the Northern Hemisphere now include, in addition to the annual flu season, preparation for the new variant of covid-19. This year it is EG.5 (named after Erida (Eris), the ancient Greek goddess of discord and chaos), a sub-variant of “omicron”, which is already prevalent in the USA, Canada and several Asian countries.
Although the World Health Organization has identified EG.5 as a “variant of concern”, it does not pose a significant threat to public health because it is a subvariant. Covid-19 is thought to have weakened: vaccines have worked and herd immunity has been achieved in some parts of the world, causing infection rates and accompanying morbidity and mortality rates to fall from their peaks in 2021 and 2022. However, is this an indication of our successful response, or were we just lucky?
Undoubtedly, the scientific community mobilized to develop tests, vaccines and other therapeutics in record time. But even at its worst, covid-19 was not as virulent or deadly as previous outbreaks. And, more importantly, the genius of science has not been accompanied by innovations in global governance.
In fact, tracking new variants has become difficult as many countries have reduced or suspended surveillance and widespread testing of suspected Covid-19 cases. Wearing masks in public and other precautions have become exceptions. This raises some important "what if" questions. What if a lethal variant appeared in one of the low-income countries, where less than 40% of the population had been vaccinated with at least one dose? What if rich countries let their guard down too soon? And perhaps most importantly: what if the new virus causes another pandemic?
Undoubtedly, there will be a "next time", and then our inability to strengthen innovation management will become apparent. Even during the covid-19 pandemic, we have repeatedly missed opportunities to use scientific achievements for the benefit of society.
In October 2020, India and South Africa requested a temporary waiver from the World Trade Organization's Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) to allow rapid production and distribution of vaccines and therapeutics in developing countries.
Despite support from the United States (at least in principle) and dozens of other countries, the deal reached in June 2022 turned out to be a shadow of the original vision. In the meantime, a scenario was realized that was supposed to prevent the abandonment of TRIPS, exposing the shortcomings of the current system.
Contrary to the widespread industry narrative that the private sector takes risks despite incredible odds, vaccine development is a long-term endeavor undertaken through public-private partnerships. Most of the fundamental research that led to the creation of mRNA vaccines has been funded for decades by governments, mainly the US, the UK and the countries of the European Union. Additional government funding has accelerated research into Covid-19 vaccines, while pre-orders of millions of doses and reductions in costs and procedures for clinical trials have complemented the subsidy regime for drugmakers. By the time the first Covid-19 vaccines arrived in the West, their production was largely risk-free for Big Pharma, leading to a “massive catastrophe of global vaccine inequality”.
Pharmaceutical companies used their oligopolistic power to negotiate better deals for their shareholders, under the cloak of confidentiality. South Africa, for example, paid twice the price of the EU for the Oxford-AstraZeneca vaccine, even though its per capita income is about a fifth of that of the EU.
Moderna is embroiled in a dispute with the National Institutes of Health over its Covid-19 vaccine patent, with NIZ arguing that three of its researchers should be listed as co-inventors. Even now, vaccine availability is woefully inadequate in many African countries, and the Access to COVID-19 Tools Accelerator, an initiative created to coordinate the equitable distribution of tests, vaccines and therapies, faces a $247 million shortfall.
In addition, covid-19 is only part of the public health picture. The African Union has set a goal of meeting 2040 percent of the continent's total vaccine needs by 60 through regional production. But even this modest goal is heavily dependent on foreign funding and faces obstacles that seem to be built into existing innovation and intellectual property systems.
A promising upcoming tuberculosis vaccine trial funded by the Bill & Melinda Gates Foundation and the Wellcome Trust has revealed a controversial commercial arrangement between the Gates Foundation and GSK, the vaccine's maker. (The Gates Foundation has long pushed for exclusive rights to drugs and reportedly persuaded Oxford University researchers to partner with biotech company AstraZeneca rather than grant non-exclusive, royalty-free licenses to its Covid-19 vaccine.)
This is important for many reasons, not least because the adjuvant AS01, used to increase the effectiveness of the vaccine, which will be supplied by GSK, has huge potential for other preparations. One of its components, QS-21, has been cultivated for centuries by the indigenous peoples of Chile, which raises the question of how much, if at all, this population benefits from the pharmaceutical monetization of that molecule.
The global community has demonstrated its ability to use science and innovation for the benefit of society. Remember how 50 years ago, when hunger and malnutrition were high on the agenda, governments, international organizations and foundations came together to fund the Green Revolution and CGIAR, a global network of agricultural research centers that made significant advances in food and agricultural technology and policies.
However, it is clear that existing governance structures are no longer fit for purpose. Imagine that an innovator presented a technological solution to climate change. The global community would almost certainly try to encourage its rapid and widespread adoption, as will other innovations that show positive externalities.
They say that "a crisis is something that is too expensive not to be used". As things stand, we will face the next health crisis largely without benefiting from the current one (which is not yet over). As innovation and intellectual property regimes remain virtually the same, we will again have to rely on - luck.
The author is a distinguished associate at the Center for Innovation in International Management
Copyright: Project Syndicate, 2023. (Translation: NR)
Bonus video:
